Read Healthcare Provider Industry Overview text version

Healthcare Payer Solutions (EMEA)

Chris Ibell VP Oracle Consulting for Healthcare ­ Europe, Middle-East and Africa

Safe Harbor Statement

The following is intended to outline our general product direction. It is intended for information purposes only, and may not be incorporated into any contract. It is not a commitment to deliver any material, code, or functionality, and should not be relied upon in making purchasing decision. The development, release, and timing of any features or functionality described for Oracle's products remains at the sole discretion of Oracle.

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Agenda

· Leadership in Healthcare · Innovation in Healthcare Solutions · Results Achieved by Oracle Customers

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Oracle in Healthcare

Did You Know?

More than 80 Healthcare Payers run Oracle applications - Oracle 20 of the Top 20 US Health Insurers run Oracle Applications - S&P More than 300 leading healthcare providers run Oracle Applications - Oracle 10 of the top 12 Fortune Global 500 healthcare organizations run Oracle Apps

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The Challenges We're Hearing

Retain and Grow Membership

"How can I grow by retaining my members and winning new ones? How can I satisfy today's empowered consumers through (self-)service?"

Mergers and acquisitions are happening in various European countries, payer organizations are becoming larger and larger and are struggling with consolidation

Comply with Changing Regulations

"How can I satisfy the big number of ever changing regulatory requirements in my country?"

Governments issuing Healthcare reform bills (structural changes), introducing privatization, reducing/changing the coverage of public health plans

Reduce Healthcare and Operating Costs

"How can I effectively use healthcare management /procurement? How can I have a benchmark cost for my operations?"

Healthcare costs are unsustainably growing, driven by fundamental factors, e.g. aging population and medical innovation

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Agenda

· Leadership in Healthcare · Innovation in Healthcare Solutions · Results Achieved by Oracle Customers

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Oracle Healthcare Payer Solutions

Retain and Grow Health Plan Membership

· Oracle Self-service Insurance, Oracle OpenBeleid and

Customer Service Center

· Oracle Self-service Insurance, Oracle OpenZorg

Comply with Changing Regulations

· Oracle OpenZorg - Health Plan Definition and Healthcare

Management

· Oracle OpenBeleid and Oracle Discoverer (or 3rd party

reporting tool) · Oracle OpenZorg, Oracle Financials

· Oracle OpenZorg Healthcare Procurement and Oracle

Reduce Healthcare and Operating Costs OpenBeleid

· Oracle OpenZorg Claims Processing · Oracle OpenZorg, Oracle OpenBeleid, Oracle Self-service

Insurance and Customer Service Center

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Oracle Healthcare Payer Solutions

Retain and Grow Health Plan Membership

· Oracle Self-service Insurance, Oracle OpenBeleid and

Customer Service Center

· Oracle Self-service Insurance and Oracle OpenZorg

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Retain and Grow Membership

Requirement Oracle Capability

Customer Service Center Oracle Self-service Insurance Siebel Marketing, Oracle Self-service Insurance and Oracle OpenZorg

The Oracle Difference

Only payer-specific self service and off-the-shelf member intelligence for all channels

Retain individual and group membership

Support recruitment and enrollment of new membership

Only payer-specific solution for recruitment and enrollment of new members

Consolidate systems as a result of mergers and acquisitions

Oracle OpenZorg and Oracle OpenBeleid

Only comprehensive off-theshelf solution in Europe

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Retain and Grow Health Plan Membership

Oracle Self-service Insurance Provides customers with an easy to use self service application Use of web and email channel for maximum convenience Ability to review and modify insurance policies at any time Ability to review instant quotes and sign up online Provides lower costs for the insurer Better quality

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Retain and Grow Health Plan Membership

Oracle Self-service Insurance Components Web application

Oracle Selfservice Insurance

Custom made solutions

DefToolTM

ComposerTM

Siebel edocs

eBilling Manager

ApplicationServer

Oracle technology

Database

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Retain and Grow Health Plan Membership

Oracle Self-service Insurance

"Open" part

·

Receive an instant quote

· For individual insurances as well as for collective agreements · Confirmation email

·

Sign-up online

· For individual insurances as well as for collective agreements · Approval by groupadministrator in case of collective agreement (configurable) · Confirmation email

·

Login

· Enrollment new user · Log in · Forgotten password

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Retain and Grow Health Plan Membership

Oracle Self-service Insurance

"Closed"part - dashboard

·

Dashboard policy owner

· · · · · Profile => modify profile data Overview policies => view policy details, modify policy Raise service requests Overview of statements => view statement details Own Risk usage Profile Service requests for validation Overview of collective agreements and policies within agreement Overview of statements => view statement details

·

Dashboard Contractor

· · · ·

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Retain and Grow Profitable Health Plan Membership

The Member-Centric Approach

CRM

Web & Email

Policies Claims Service Requests Interactions

Back Office

Member Member Information Information

Contact Centre

Single secure repository of member interaction history Multi-channel access Unified platform for new "customer focused" services

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Oracle Healthcare Payer Solutions

Comply with Changing Regulations

· Oracle OpenZorg - Health Plan Definition and Healthcare

Management

· Oracle OpenBeleid and Oracle Discoverer (or 3rd party

reporting tool) · Oracle OpenZorg, Oracle Financials

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Comply with Changing Regulations

Requirement

Deliver adaptive and flexible back-office process support

Oracle Capability

Oracle OpenZorg - Health Plan Definition and Healthcare Management/ Procurement

The Oracle Difference

Only Oracle OpenZorg supports user-defined and changing business rules, for both public, private and mixed environments Only Oracle OpenBeleid offers off-the-shelf star schema's for claims and member data combined

Support mandatory reporting requirements

Oracle OpenBeleid and Oracle Discoverer (or 3rd party reporting tool)

Support changing accounting needs

Oracle OpenZorg, Oracle Financials

Only payer solution where integration with the general ledger is supported via userdefined translation rules

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Comply with Changing Regulations

Oracle OpenZorg

Oracle OpenZorg Payer Solution: Key Components

·Policy Management ­ supports the entire process from enrollment to premium calculation, automatically producing customer documentation such as policy statements and healthcare entitlement cards, as well as invoices and financial transactions. Retroactive policy changes are supported with automatic premium recalculation. ·Claims Processing ­ provides an integrated claims solution where claims from policy holders or healthcare providers are automatically adjudicated based on configurable business rules, leading to straight-through processing and payment. Claims can be processed online or in batch and can be corrected automatically. Bi-directional exchange of claims information with healthcare providers is supported. ·Health Plan Definition ­ allows for the definition of an unlimited number of health insurance products for individually insured persons and collective contracts. Health plans defined by law and legislation can be created, and changes can be handled by adapting product definitions. Policy Management and Claims Processing can immediately use all new and modified product definitions. ·Healthcare Procurement ­ supports all levels of agreements with healthcare providers, ranging from professional group level to individual contracting. Agreements can be specified down to treatment level (also at DRG level). Claims Processing will directly check all types of agreements. The flexibility in Product Definition and Healthcare Procurement enables client-specific rule definitions to be entered without any programming effort.

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Comply with Changing Regulations

Oracle OpenBeleid: Understanding Your Business

·Solution for reporting and analysis

· · · · · · · mandatory (external) reporting claims analysis for cost control provider comparisons for benchmarking product/health plan profitability, also premium calculation input member analytics influx, outflux financial reporting

·Directly suitable for end users (no IT staff needed) ·Separate Data Warehouse with Discoverer query tool

· end user layer included

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Comply with Changing Regulations

OpenBeleid Star Schemas (Datasets)

· · · · · · Claims/Declined claims Premiums Insured persons Financial flow Influx ­ Outflux Medical Authorizations

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Comply with Changing Regulations

Flexible Accounting Solution

Description

· Flexible Chart of Accounts · User-editable accounting rules · Translation rules from Oracle

OpenZorg · Multiple accounting and currency representations · Subledger daybooks (journals) · Flexible reporting and inquiries

French Fiscal

US GAAP

Dr

Cr

Centralized Accounting

Payables Invoice

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Oracle Healthcare Payer Solutions

· Oracle OpenZorg Healthcare Procurement and Oracle

Reduce Healthcare And Operating Costs OpenBeleid

· Oracle OpenZorg Claims Processing · Oracle OpenZorg, Oracle OpenBeleid, Oracle Self-service

Insurance and Siebel Call Center

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Reduce Healthcare and Operating Costs

Requirement

Drive effective care purchasing through advanced analytics

Oracle Capability

Oracle OpenZorg Healthcare Procurement and Oracle OpenBeleid

The Oracle Difference

Most advanced functionality for managing agreements and supporting negotiations with all healthcare providers Only fully automated claims adjudication engine checking all health plan definitions and provider agreements

Optimize claims autoadjudication in compliance with the health plan rules and provider agreements

Oracle OpenZorg Claims Processing

Streamline operations, minimize manual processes, reduce errors and paper output

Oracle Self-service Insurance and Customer Service Center

Only integrated off-the-shelf modular solution from front to back office with analytics

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Reduce Healthcare and Operating Costs

Oracle OpenZorg

Comprehensive Back Office Solution for Healthcare Payers

Both public and private Both public and private Covers all primary processes and many supporting processes Covers all primary processes and many supporting processes Multi-organization and multi-brand support Multi-organization and multi-brand support Both direct and intermediary channels Both direct and intermediary channels Both individual and collective market Both individual and collective market Flexible products- and healthcare procurement engine Flexible products- and healthcare procurement engine Reusable data components -> efficient maintenance Reusable data components -> efficient maintenance Connective, Robust and Scalable Connective, Robust and Scalable Separate, but fully integrated Data Warehouse (Oracle OpenBeleid) Separate, but fully integrated Data Warehouse (Oracle OpenBeleid) Separate, but fully integrated Self-service solution (OSI) Separate, but fully integrated Self-service solution (OSI)

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Oracle Support for Healthcare is Complete

·

Consulting

Healthcare applications capabilities

· · Database technology to support small to large and multiple healthcare organizations Access, Identity management and security that is world reknown Only complete standards-based, semantically interoperable Health Information Exchange (HIE) Most out-of-the-box self-service transactions (100s) to reduce HR costs Only integrated contracting, procurement, and payment for materials and contingent nursing staff solution ERP, CRM, HCM and more Most scalable, reliable, secure infrastructure Most complete range of on-demand and on-premise deployment options 29,000+ across 145+ countries

Applications/ Business Intelligence

· · ·

HTB

Tools / J2EE

Fusion Middleware

·

#1 enterprise software vendor

· · ·

Database

·

Operating System

Largest development, consulting and support team

·

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Oracle Healthcare Payer Solutions

Summary

· Retain and grow health plan membership · Comply with changing regulations · Reduces healthcare and operating costs

Oracle Self-service Insurance Siebel CRM Oracle OpenZorg Oracle OpenBeleid Oracle Financials Oracle Technology platform

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Agenda

· Leadership in Healthcare · Innovation in Healthcare Solutions · Results Achieved by Oracle Customers

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Delta Lloyd Group Consolidates Back-Office using Oracle Payer Solutions

COMPANY OVERVIEW

Delta Lloyd Group is a banking and insurance group employing approximately 6,500 staff (in FTEs). The Group consists of eight divisions active in four countries, with the following core activities: Delta Lloyd Insurance; insurance and pension services via independent intermediaries in the Netherlands OHRA Insurance; insurance and pension services sold direct to personal and business customers in the Netherlands ABN AMRO Insurance; insurance and pension services via the distribution network af ABN AMRO Bank in the Netherlands Delta Lloyd Asset Management; Delta Lloyd Banking; Delta Lloyd Property; Delta Lloyd Germany; Delta Lloyd Life Belgium

CUSTOMER PERSPECTIVE

"Oracle enables the combination of forces in the market. In the turbulent healthcare market with many changes in law and legislation, costs are an important issue. Therefore reinventing the wheel is undesirable. With Oracle we work with state-of-the-art technology and with people who are solutionoriented and available when needed." - Ingrid Visscher, chairman of the board of Delta Lloyd Healthcare.

CHALLENGES OPPORTUNITIES

·Pursued consolidation of back office systems to achieve cost reductions (uniform processes, one application, system)

RESULTS

· Multi brand, multi organization implementation · Consolidated back-office across different organisational units and implemented standard processes

SOLUTIONS

Oracle OpenZorg Oracle Database 10g, Oracle Fusion Middleware 10g Current implementation: The last part of Ohra insured persons are migrated to Oracle OpenZorg leading to an implementation with all 800.000 insured persons

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Azivo Implements Efficient Back-Office Payer Solutions

CUSTOMER PERSPECTIVE

COMPANY OVERVIEW

Azivo is a regional mutuality with 150.000 insured persons. It's customer base is a combination of public (largest part) and private.

CHALLENGES/OPPORTUNITIES

·Replacement of old claims application ·Need to gain efficiencies in the back office ·Needed timely management information support to support external reporting requirements and provider network comparative analyses

"With a multi-year contract for Oracle OpenZorg, Azivo created certainty for a stable and efficient execution of its Healthcare Insurance back-office. To us OpenZorg means a flexible and customisable backoffice." Aad de Groot, General Manager

SOLUTIONS

Oracle OpenZorg, Oracle OpenBeleid Oracle General Ledger Oracle Database 10g, Oracle Fusion Middleware 10g

RESULTS

· One of the lowest number of FTEs for claims processing by electronic exchange with Healthcare Providers · Azivo was awarded as being the fastest (mandatory) reporting Healthcare Payer in the Netherlands. Before implementing Oracle OpenBeleid it was one of the slowest in reporting.

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Unive-VGZ-IZA-Trias (UVIT) Largest Dutch Healthcare Payer

COMPANY OVERVIEW

The Netherlands' largest Healthcare Payer, Unive-VGZ-IZA-Trias insures more than 4 million people and manages an average of 200,000 claim lines every single calendar day.

CUSTOMER PERSPECTIVE

"Oracle OpenZorg is of strategic importance to VGZ-IZA. The multi-year contract reflects our confidence in the continuity Oracle can offer us." Chris Driessen, Board member

CHALLENGES/OPPORTUNITIES

·Needed the agility to respond rapidly to frequent, complex changes in Dutch healthcare insurance law ·Operate industry best-practice policy and claims management processes within an integrated IT environment ·Analyze costs of providing healthcare insurance and assess profitability of individual and collective policies in portfolio ·Streamline mandatory reporting to external regulatory bodies ·Cut IT management costs by eliminating the need to build and maintain interfaces between more than 100 applications

RESULTS

· Before implementation of Oracle OpenZorg VGZ could not handle the increasing volumes anymore. Afterwards it has reached unlimited scalability in order to enable its Merger and Acquisition strategy · Implemented business processes from head to tail; Oracle web application, backoffice, analytics and call center · VGZ reduced the number of applications and interfaces significantly

SOLUTIONS

Oracle OpenZorg Oracle OpenBeleid Oracle Self-service Insurance (based on Siebel edocs) Siebel CRM for call center Oracle Database 10g Oracle Fusion Middleware 10g

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The Oracle Difference

Only Oracle...

·Only Oracle Self-service Insurance complete off the shelf payerspecific solution for recruitment and enrollment of new members ·Only Siebel CRM offers payer-specific call center and off-theshelf payer intelligence for all channels ·Only Oracle OpenZorg offers fully automated claims adjudication engine checking all health plan definitions and provider agreements ·Only Oracle OpenBeleid offers off-the-shelf analytics for claims and member data combined

Only integrated off-the-shelf modular solution from front- to back-office with analytics

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Information

Healthcare Provider Industry Overview

31 pages

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